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BMJ. 2019 Jan 16;364:k5300. doi: 10.1136/bmj.k5300.

Financial interests of patient organisations contributing to technology assessment at England's National Institute for Health and Care Excellence: policy review.

Author information

1
Centre for Health Economics in London, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK kate.mandeville@lshtm.ac.uk.
2
University of Oxford, Oxford OX1 2JD, UK.
3
Royal Free Hospital, London NW3 2QG, UK.
4
Department of Psychology, City University, London EC1V 0HB, UK.
5
Lewisham and Greenwich NHS Trust, London, UK.

Abstract

OBJECTIVE:

To investigate the prevalence of financial interests among patient organisations contributing to health technology assessment at the National Institute for Health and Care Excellence (NICE) in England and the extent to which NICE's disclosure policy ensures that decision making committees are aware of these interests.

DESIGN:

Policy review using accounts, annual reports, and websites of patient organisations; payments declared by pharmaceutical manufacturers on their websites and a centralised database (Disclosure UK); declarations of interests by nominated representatives of patient organisations; and responses from patient organisations.

SETTING:

Appraisals of medicines and treatments (technologies) for use in the English and Welsh National Health Service.

PARTICIPANTS:

53 patient organisations contributing to 41 NICE technology appraisals published in 2015 and 2016, with 117 separate occasions that a patient organisation contributed to the appraisal of a technology.

MAIN OUTCOME MEASURES:

Prevalence of specific interests (that is, funding from manufacturer(s) of a technology under appraisal or competitor products); proportion of specific interests of which NICE's decision making committees were aware; proportion of unknown specific interests for which disclosure was not required by NICE's policy RESULTS: 38/53 (72%) patient organisations had accepted funding from the manufacturer(s) of a technology or a competitor product in the same year that they had contributed to the appraisal of that technology or the previous year. Specific interests were present on 92/117 (79%) occasions that patient organisations contributed to appraisals in 2015 and 2016. NICE's decision making committees were aware of less than a quarter of specific interests (30/144; 21%). For nearly two thirds of the specific interests not known to committees (71/114; 62%), disclosure by patient organisations was not required by NICE's policy.

CONCLUSIONS:

Financial interests are highly prevalent among patient organisations contributing to health technology assessment. NICE should review its disclosure policy to ensure that decision making committees are aware of all relevant interests.

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: HP is an employee of NICE, including during the conduct of this study; no other members of NICE had a role in the analysis of data; findings and drafts were shared with NICE to facilitate policy change, but the authors retained editorial control; HP is also the chair of trustees for a local branch of a national patient organisation Mind; Mind asks staff and trustees to adhere to their policy that restricts funding from pharmaceutical companies (full details of the policy can be found at https://www.mind.org.uk/workplace/corporate-partnerships/guidelines-for-corporate-partners/); KLM undertook a specialty training placement (but was not employed) at NICE before starting this work; no other support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

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